Which presentation indicates Vertebral Artery Dissection risk?

Which presentation indicates Vertebral Artery Dissection risk?

• A. Fever + stiff neck + altered mental status
• B. Aortic dissection
• C. Sudden severe headache + ptosis/miosis (Horner's) after adjustment = ER Stroke alert
• D. Saddle anesthesia

Answer: (C)

Recognizing a posterior circulation vascular event after neck manipulation is the key idea. Sudden severe head or neck pain after an adjustment, especially when accompanied by Horner’s syndrome (ptosis and miosis), strongly points to vertebral artery dissection with potential posterior circulation stroke. The neck manipulation can injure the vertebral artery, and disruption of sympathetic fibers explains the Horner’s signs. This combination signals a cerebrovascular emergency needing immediate stroke assessment and imaging. Other scenarios don’t fit as well: fever with stiff neck and altered mental status suggests meningitis or encephalitis; chest or back tearing pain would point toward aortic dissection; saddle anesthesia indicates cauda equina syndrome.

Recognizing a posterior circulation vascular event after neck manipulation is the key idea. Sudden severe head or neck pain after an adjustment, especially when accompanied by Horner’s syndrome (ptosis and miosis), strongly points to vertebral artery dissection with potential posterior circulation stroke. The neck manipulation can injure the vertebral artery, and disruption of sympathetic fibers explains the Horner’s signs. This combination signals a cerebrovascular emergency needing immediate stroke assessment and imaging.

Other scenarios don’t fit as well: fever with stiff neck and altered mental status suggests meningitis or encephalitis; chest or back tearing pain would point toward aortic dissection; saddle anesthesia indicates cauda equina syndrome.